Care & Transitions Facilitator Trauma
3 weeks ago
The Care & Transitions Facilitator is a practitioner in the Trauma Neurosurgery program that is results oriented and committed to enhance the quality of patient care within a complex health, social and fiscal environment. As a clinical expert, you will be instrumental in coordinating the use of clinical resources for patients at key points of transition in care. Working collaboratively with the interdisciplinary team, you will be responsible for facilitating the patient journey through assessment, care planning, transitions and follow-up at discharge from acute care. A key component of the role is reducing fragmentation, mitigating barriers and coordinating patient care during key transition points in care.
RESPONSIBILITIES: Care Facilitation:
- Assess the needs of patients and families working to advance all patient journeys in order to reduce delays in service/disposition
- Coordinate clinical resource use for exceptional and complex patients
- Communicate effectively with medical/interdisciplinary/unit teams and patients/families to enrich patient progress
- Coordinate care delivery with internal and external stakeholders liaising with outside agencies to facilitate the initiation of timely and appropriate medical, functional and rehab services
- Advocate for patient services needed for a safe and effective discharge/transition
- Negotiate with reluctant or challenging patients for limited services or space Identify patient care/safety issues working to resolve issues and communicate concerns to the unit Clinical Leader Manager (CLM)
- Utilize expert knowledge and leverage external resources to reduce system barriers and facilitate safe and timely discharges
- Take a lead role in ensuring the trauma program meets it’s mandate of providing trauma care prevention initiatives and maintaining linkages with site and system injury prevention stakeholders
- Under the direction of the CLM, act as a resource for patient care issues and problem solve in collaboration with cross program and community teams to ensure effective and efficient patient access, flow, and transitions in care
**Education**:
- Under the direction of the CLM act as clinical resource for the interdisciplinary team and front line staff
- Encourage bedside nurses’ active involvement in patient care plan and discharge activities
- Collaborate with CLM to engage staff to reach consensus related to care by providing direct or indirect assistance, guidance or supervision along the continuum of care
Quality Improvement/Research:
- Update knowledge by participating in educational opportunities, reading professional publications, maintaining personal networks, participating in professional organization
- Support the CLM and team in the implementation of unit/program based quality improvement initiatives Facilitate a multidisciplinary approach to quality and cost-effective complex patient care in the acute setting Identify/analyze care practices & system processes that contribute to/impede outcomes and make recommendations related to evaluation and redesigning processes
Administrative:
- Develop care management tools (assist in development of care maps/patient protocols for high volume procedures/diagnosis)
- Participate in internal and external committees/working groups
- Performs cross functional and other duties as assigned and/or requested
QUALIFICATIONS:
- Regulated Health Professional with a Bachelor of Science Degree in Nursing/Health Discipline required Registration in good standing with a regulatory college is required
- Master's degree would be considered an asset
- Current and advanced clinical assessment skills related to the needs of the program are required in the area of Trauma Neurosurgery Demonstrated ability in problem solving
- Proven success in generating ideas for effective case management
- Excellent communication, facilitation and negotiation skills
- Demonstrated ability to facilitate effective teamwork among a group of multi-disciplinary professionals
- Proven ability to plan, organize and coordinate various activities
- Demonstrated ability to manage competing priorities and balance multiple, disparate tasks Proficiency in the use of computers with proven experience in data interpretation and extraction of information
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Toronto, Ontario, Canada St Michael's hospital Full timeCare & Transitions Facilitator Trauma & Neurosurgery (Job ID: 4665) Posting Description The Care & Transitions Facilitator is a practitioner in the Trauma Neurosurgery program that is results oriented and committed to enhance the quality of patient care within a complex health, social and fiscal environment. As a clinical expert, you will be instrumental in...
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Toronto, Canada St Michael's hospital Full timeCare & Transitions Facilitator Trauma & Neurosurgery (Job ID: 4665) Posting Description The Care & Transitions Facilitator is a practitioner in the Trauma Neurosurgery program that is results oriented and committed to enhance the quality of patient care within a complex health, social and fiscal environment. As a clinical expert, you will be instrumental...
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